Awareness of the Use of Environmental Management in the Control and Prevention of Malaria (a Case Study of Ifako Ijaiye Lga)
Chapter One
Objective of the study
The main objective of this study is to explore community knowledge and practices on environmental management for malaria control. Specifically, our goal is to:
- Assess the environmental management practices used by community members.
- evaluate the relationships among knowledge, beliefs, and environmental management practices.
- Identify key challenges and opportunities for improving the effectiveness of environmental management in this region as well as in a larger context.
CHAPTER TWO
LITERATURE REVIEW
Epidemiology of malaria.
Malaria, a mosquito-borne Protozoa disease, is older than recorded history; and probably plagued prehistoric man. The first record of a treatment for the disease dates from 1600 AD, in Peru, and utilized the quinine rich bark of the cinchona tree (Garnham, 1966). Scientifically, it is not a newly described disease.
Approximately 40% of the world’s population lives in regions where malaria transmission is endemic, mainly tropical and subtropical regions (Aultman et al., 2002). Malaria has been successfully controlled, in fact effectively eliminated, in temperate regions of the world (Sachs and Malaney, 2002). The control strategies employed in temperate regions included changes in agricultural and construction practice reducing the availability of standing water and targeted vector control using insecticides such as DDT (Greenwood and Mutabingwa, 2002). Industrialization and improved housing conditions were instrumental in the elimination of the disease in temperate countries (Budiansky, 2002). The role of mosquito in the life cycle of P. falciparum requires that the parasite be able to maintain an extended infection in order to ensure transmission ability during the following season (Kyes et al., 2001). Now that the sequences of the three participants in the life cycle of human malaria, Plasmodium species, Anopheles species, and Homo sapiens, are all complete and available in endemic areas, perhaps new strategies of disease control will succeed.
Malaria is distributed mainly between latitudes 450-670 south (Clyde, 1981). These regions embrace about 102 countries or areas of the world reported with indigenous malaria. These areas are typically in the tropical belt.
In studying the malaria situation and distribution, China and India have continued to report downward trends. However, the malaria situation continues to deteriorate in rural area where intensive economic, social, behavioural and technical factors are taking place, particularly in Asia and America, while in the remaining area, it is fluctuating.
African countries lying in the tropical belt have been known to be highly endemic for malaria, particularly in the early 1970s when malaria deaths were estimated to be in the order 9, 750,000 annually.
The most common type of malaria caused by P. vivax occurs in the temperate regions, whereas P. falciparum is largely confined to the tropics, P. malariae is considerably rarer and has a focal distribution, P. ovale, rather than P. vivax is the benign relapsing fever in West Africa but it is found less frequently in other parts of Africa. This pattern of distribution is because P.vivax (not P. ovale) requires Duffy blood group receptors on erythrocyte membrane and these receptors are lacking in many Africans, particularly west African (Miller et al., 1976).
Chloroquine-resistance and P. falciparum malaria has now been confirmed in more than 40 countries, but the situation tends to deteriorate further, especially in Africa, as the drug pressure on the parasites increase in the absence of substantive vector control. Sulfadoxine/pyrimethamine resistance has now been reported from 11 countries and resistance to mefloquine reported in the Philippines, the United Republic of Tanzania and Thailand. P. falciparum continues to be sensitive to these drugs in Middle America, the Caribbean, West Africa and most countries in Asia, west of India.
Figure 1 shows global distribution of malaria as shown in the world map. The unshaded region shows areas (which occupies 28% of world population) where malaria either never existed or disappeared without specific anti-malaria measures, while the doted areas correspond to region (16% of the world population), in which the disease has been eliminated during recent decade by the general improvement of health service, changes in the environment and successful anti-malaria activities and the striped regions correspond to region (about 50% of world population), in which anti-malaria measures are carried out because of the prevalence or endemicity of the malaria disease (WHO, 1986).
In many of these areas the health infrastructure is not sufficiently developed to ensure that the favorable epidemiological situation is maintained. Their epidemiological situation is precarious as they are under the constant threat of intensification and spread of specific malaria problems, such as resistance of parasites to drugs or vectors to insecticides, thus making control measure less effective and more costly. Although efforts are being made to incorporate appropriate anti-malaria activities into developing primary health care systems, progress appears to be slow, managerial and organizational problems persist (WHO, 1986).
In Africa north of Sahara, transmission continued to be limited to a small facet. The total number of cases reported in this area increased from 453 in 1983 to 666 in 1984. An increase of transmission was observed in the northern provinces of Morocco.
In Africa south of the Sahara, the malaria situation did not change. In the malarious areas, endemicity varies greatly from place to place although in general, malaria prevalence has remained unchanged. It has been estimated that some 115 million cases occur in meso-endemic zone and 231 in areas where malaria is hyper-endemic to holo-endemic. In most of these countries, vector control operations are not feasible, especially in rural areas, for a variety of technical, operational, administrative and financial reasons. The only action that could be currently attempted in these countries is the prevention and reduction of mortality and morbidity through the rational use of anti-malaria drug. But one of the major constraints hampering the implementation of these anti-malaria actions is the lack or shortage of trained personnel for the planning, organization, monitoring and evaluation of programmes that are carefully designed with clearly stated objectives and targets that can actually be implemented and maintained according to the available resources and local conditions (WHO, 1986).
In America, among the problem affecting the anti-malaria programmes, the most important are the resistance of the principal vector, Anopheles albimanus in Middle America from the south of the Mexico to Panama as well as Haiti and resistance of P. falciparum to chloroquine in South America, especially in Brazil and Colombia (Amazonas areas, Magdalema valley and the areas of Catatumbo and Turbo). All these countries were affected by the finance crises which led to a limitation of the anti-malaria measures.
In Asia west of India which has about 215 million people, about 181 million people live in areas which are originally malarious, 15 million people live in areas which have been freed from the disease and 35 million in areas where risk is limited. However, Bahrain, Cyprus, Israel, Jordan, Kuwait, Lebanon, Qatar remained free of indigenous malaria. The surveillance schemes operated in these countries are considered adequate to avoid the reestablishment of transmission despite the very high number of imported cases. Among the countries with nation wide anti-malaria activities, a reduction in the number of cases reported was observed in the Islamic Republic of Iran, Saudi Arabia, the Syrian Arab Republic and the United Arab Emirates.
In India, where some 370 million people live in high transmission area, the overall malaria situation appears to have stabilized around an incidence level of some 2 million cases reported (WHO, 1986). During 1984, national monitoring teams confirmed the resistance of P. falciparum to chloroquine in new area in Andhra, Pradesh, Bihar, Gujarat and Orissa states. Vector in rural area, Anopheles culicifaecies is resistant to DDT and occasionally also to mal-action in treated areas of many districts. Its resistance to fenitrothion and propoxur has also been reported in some areas along the Gujarat/Maharashtra border. Countries like Australia, Brunei, Jerusalem, the Democratic People’s Republic of Korea, Hongkong, Japan Macoa, Mongolia, Singapore, large areas of China and most of Oceanic are considered to be free of malaria (WHO, 1986)
Endemic malaria accumulates in certain areas of Turkey following the peak of the epidemic in 1977 with 115,000 cases; emergency measures had reduced the incidence to 29,000 cases in 1979. Recent survey in France has shown that number of imported cases in these countries alone was in the order 2,000 compared with some 50 cases reported to World Health Organization.
Also Adenosine Triphosphate deficiency in non-immune Negro males seems to lower morbidity and mortality level in P. falciparium infection (Brewer and Powel, 1965).
CHAPTER THREE
RESEARCH METHODOLOGY
Study Design
It is a term used to describe a number of decisions which need to be taken regarding the collection of data before they are collected. (Nwana, 1981). It provides guidelines which direct the researcher towards solving the research problem and may vary depending on the nature of the problem being studied. According to Okaja ( 2003, p. 2),” research design means the structuring of investigation aimed at identifying variables and their relationship, it is used for the purpose of obtaining data to enable the investigator test hypothesis or answer research question by providing procedural outline for conducting research”. It is therefore, an outline or scheme that serves as a useful guide to the researcher in his efforts to generate data for his study.
This cross-sectional study used mixed methods (both quantitative and qualitative). It is used to obtain the peoples opinion through questionnaire.
Study Area
This study was carried out in Ifako-Ijaiye. Ifako-Ijaiye is a city and local government area in Lagos, Nigeria. It has a land area of 43 square kilometres (17 sq mi) and had a population of 427,878 people in 2006. The Ifako-Ijaiye Local Government was created along with 183 other local governments on October 1, 1996 by General Sani Abacha, the then military head of state. It was carved out of Agege Local Government, with headquarters in Ifako. The 1991 census found the majority of inhabitants to be Yoruba. Ifako-Ijaiye Local Government is a border suburb town as it shares border with Ogun State. The major settlements are Ogba-Ijaiye, Ifako, Oke-Ira, Iju-Ishaga, Obawole, Iju-Ogundimu, Fagba, Agege Pen Cinema among others.
Population of the study
A study population is a group of elements or individuals as the case may be, who share similar characteristics. These similar features can include location, gender, age, sex or specific interest. The emphasis on study population is that it constitute of individuals or elements that are homogeneous in description (Prince Udoyen: 2019). In this study the study population constitute of the whole people in Ifako-Ijaiye Local Government . According to the Federal republic of Nigeria Official Gazette 2006 census population of Ifako-Ijaiye Local Government is 427,878. Accordingly Lagos grew at 2.5% annual growth rate which reveals that between 2006 and 2018 the projected population figure or growth was 700,126. Therefore , one –quarter of this population forms the population of Ifako-Ijaiye Local Government household according to the Federal Republic of Nigeria Official Gazette which is 175,032. Hence, this forms the population of the study.
CHAPTER FOUR
PRESENTATION OF DATA AND ANALYSIS
Demographic Distribution
Table 4.1 summarizes key demographic and socioeconomic characteristics of the 408 survey respondents. As intended, the sample was split nearly evenly between males and fe- males, and the average age of respondents was 42 years. Approximately two-thirds of respondents were Muslims and one-third were Christians. Educational attainment was quite low; 40% of respondents had no education and 53% had only a primary school education. The majority of the sample (83%) engaged in crop farming as their main occupation, 7% were pastoralists or mixed farmers (crops and livestock keeping), and 5% were employed in business activities. People younger than aged 17 years and adult students were not interviewed for the study.
CHAPTER FIVE
CONCLUSIONS AND RECOMMENDATIONS
Conclusions
Starting from the belief that community-level environmental management is a promising component of an integrated vector management program, our study sheds light on current knowledge and practices among residents in one part of Lagos. Most respondents understand that there is a link between environmental conditions and malaria, and the majority engages in environmental management practices for malaria control. Yet, with limited time and resources to devote toward malaria control, it is crucial that environmental management efforts are focused on techniques that actually lead to reductions in anopheline mosquitoes in a given area. Additionally, it is important to identify areas in which environmental management will not be an effective malaria control technique and to focus control resources elsewhere for those communities.
The creation of an educational program on environmental management for malaria control, paired with incentives or regulations, could lead to significant increases in community participation in effective techniques. The program should concentrate on teaching participants about mosquito ecology, clarifying which environmental management techniques effectively lower Anopheles spp. mosquito abundance versus those that are ineffective, and stressing the importance of community participation and cooperation in the success of this form of malaria control. With greater knowledge and participation, environmental management could result in lasting, sustainable reductions in malaria burden for many communities in Nigeria and other malaria-endemic areas.
Recommendations
Based on the findings of this study, the following are recommended:
- There is need to enlighten the public on the importance of practicing preventive measures at home and community levels.
- Intensify social marketing on use of artemisinin combined therapy and its advantage.
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